First U.S. MERS patient may go home soon

The patient diagnosed with the first U.S. case of Middle Eastern respiratory syndrome coronavirus continues to improve and is expected to be released to home isolation soon, according to a May 7 update from Community Hospital in Munster, Ind. He will remain in home isolation until he is cleared by the Indiana State Department of Health and the CDC as no longer being an infectious risk to the public.

“During the patient’s stay in the hospital, other patients or visitors were not at risk because the patient was in a private setting at all times,” Don Fesko, Community Hospital CEO, said in a recent news release. “The MERS virus is believed to require very close contact for transmission.”

On April 24, the patient — a male healthcare worker who lives in Saudi Arabia — traveled by plane from Saudi Arabia to London, and then from London to Chicago. The patient took a bus from Chicago to Indiana to visit family. On April 27, he began to experience respiratory symptoms including shortness of breath, coughing and fever, according to the CDC. He was admitted to the hospital on April 28. He tested positive for MERS-CoV on May 2.

As a precautionary measure, employees who had direct contact with the patient remain off duty in temporary home isolation and are being closely monitored for symptoms. Following the end of the employees’ incubation period, employees will be undergoing tests to confirm a second negative result for MERS, at which time they will be cleared to return to work, according to the hospital release.

MERS first was reported in 2012 in Saudi Arabia, according to the CDC website. All reported cases to date have been linked to the Arabian Peninsula, including Saudi Arabia, Jordan and Kuwait. Countries with travel-associated cases include the United Kingdom, France, Tunisia, Italy, Malaysia and now the U.S., according to the WHO. About 36% of people with MERS have died. Most of the people who died had an underlying medical condition, and in some cases, those infected experienced only mild symptoms or were asymptomatic.

Guidelines for healthcare professionals

The CDC does not recommend that anyone change their travel plans because of the MERS case. However, because MERS has spread in healthcare settings in other countries, a CDC alert advises travelers going to countries in or near the Arabian Peninsula to provide healthcare services to follow the CDC’s recommendations for infection control of confirmed or suspected cases.

The CDC recommends that healthcare professionals evaluate patients for MERS infection if they develop fever and symptoms of respiratory illness, such as cough or shortness of breath, within 14 days after traveling from countries in or near the Arabian Peninsula. They also should evaluate patients for MERS infection if they have had close contact with a symptomatic recent traveler from this area.

Additional guidelines for healthcare professionals are provided at www.CDC.gov.

CDC briefing provides more details

During a May 2 CDC press briefing, Anne Schuchat, MD, the director of the National Center for Immunization and Respiratory Diseases at the CDC, said as of that day, 252 people in 12 countries have been confirmed to have the MERS infection; 93 of these people have died. Schuchat also said that based on available information, individuals with pre-existing health conditions or weakened immune systems may be more likely to become infected with or have a severe case of the illness.

In some countries, the virus has spread from infected people to others through close contact and has spread in hospitals, Schuchat said, but there is no evidence of sustained spread in community settings.

“It is very concerning that the virus has spread in hospitals, and we should not be surprised if additional cases are identified among the healthcare providers who had close contact with this patient before the patient was isolated and special precautions were implemented,” Schuchat said during the briefing.

The CDC has been working with partners to better understand the risks of this virus, including the source, how it spreads and how infections might be prevented. Schuchat said the Indiana MERS patient was providing healthcare in Riyadh, Saudi Arabia, but did not fall ill while there. “The person developed symptoms in the United States,” she said. “The assumption is the person acquired the illness in Saudi Arabia.”

Schuchat said an increase in cases since March of this year and several cases in spring 2013 have led to the question of whether the factors that lead to MERS may have a seasonal pattern.

“In this interconnected world we live in, we expected MERS to make it to the United States,” she said. “… these new diseases are just a plane ride away. It’s really important that we cooperate internationally and that’s been absolutely vital with the MERS response. That’s a lesson that we have been learning over and over as we really try to strengthen global health security worldwide.”

Schuchat said the age range is vast with the youngest patient being 2 and the median age at about 51. “The emerging respiratory viruses really need a travel history to raise suspicion,” she said.

There are no anti-viral drugs for MERS and no recommended specific treatment. Medical care is supportive and aims to help relieve symptoms.

For information about cases and deaths by country, visit the World Health Organization’s website at http://www.who.int/en/.